Collective international action to increase access to costly drugs: pooled procurement and equity based tiered pricing

Current pricing mechanisms, operating in fragmented national systems, often leave less populous and lower income countries with limited negotiating power and higher relative prices. The Oslo Medicines Initiative (OMI), led by the World Health Organization Regional Office for Europe, identified international collaboration in collective strategies to tackle persistent challenges in securing affordable and equitable access to costly new drugs.1 The OMI did not specifically endorse any single approach, but it recognised “pooled procurement” and “equity-based tiered pricing” as potential approaches that might overcome the limitations of nationally based policies by increasing bargaining power, reducing administrative burdens, and lowering drug prices.This article, part of a BMJ Collection on equitable access to costly new drugs (www.bmj.com/collections/novel-medicines), explores how these collaborative strategies work and how they should be tested. Implementation of these initiatives will require greater price transparency based on equity oriented principles, commitment from stakeholders (including healthcare payers from both higher and…